Phase 3 Trial of Epicutaneous Immunotherapy in Toddlers with Peanut Allergy
Authors: Matthew Greenhawt, Sayantani B. Sindher, Julie Wang, Michael O’Sullivan, George du Toit, Edwin H. Kim, Deborah Albright, Sara Anvari, Nicolette Arends, Peter D. Arkwright, Philippe Bégin, Katharina Blumchen, Thierry Bourrier, Terri Brown-Whitehorn, Heather Cassell, Edmond S. Chan, Christina E. Ciaccio, Antoine Deschildre, Amandine Divaret-Chauveau, Stacy L. Dorris, Morna J. Dorsey, Thomas Eiwegger, Michel Erlewyn-Lajeunesse, David M. Fleischer, Lara S. Ford, Maria Garcia-Lloret, Lisa Giovannini-Chami, Jonathan O. Hourihane, Nicola Jay, Stacie M. Jones, Leigh Ann Kerns, Kirsten M. Kloepfer, Stephanie Leonard, Guillaume Lezmi, Jay A. Lieberman, Jeanne Lomas, Melanie Makhija, Christopher Parrish, Jane Peake, Kirsten P. Perrett, Daniel Petroni, Wolfgang Pfützner, Jacqueline A. Pongracic, Patrick Quinn, Rachel G. Robison, Georgiana Sanders, Lynda Schneider, Hemant P. Sharma, Juan Trujillo, Paul J. Turner, Katherine Tuttle, Julia E. Upton, Pooja Varshney, Brian P. Vickery, Christian Vogelberg, Brynn Wainstein, Robert A. Wood, Katharine J. Bee, Dianne E. Campbell, Todd D. Green, Rihab Rouissi, Aurélie Peillon, Henry T. Bahnson, Timothée Bois, Hugh A. Sampson, A. Wesley Burks
Journal: New England Journal of Medicine (2023)

No approved treatment for peanut allergy exists for children younger than 4 years of age, and the efficacy and safety of epicutaneous immunotherapy with a peanut patch in toddlers with peanut allergy are unknown. We conducted this phase 3, multicenter, double-blind, randomized, placebo-controlled trial involving children 1 to 3 years of age with peanut allergy confirmed by a double-blind, placebo-controlled food challenge. Patients who had an eliciting dose (the dose necessary to elicit an allergic reaction) of 300 mg or less of peanut protein were assigned in a 2:1 ratio to receive epicutaneous immunotherapy delivered by means of a peanut patch (intervention group) or to receive placebo administered daily for 12 months. The primary end point was a treatment response as measured by the eliciting dose of peanut protein at 12 months. Safety was assessed according to the occurrence of adverse events during the use of the peanut patch or placebo. Of the 362 patients who underwent randomization, 84.8% completed the trial. The primary efficacy end point result was observed in 67.0% of children in the intervention group as compared with 33.5% of those in the placebo group (risk difference, 33.4 percentage points; 95% confidence interval, 22.4 to 44.5; P<0.001). Adverse events that occurred during the use of the intervention or placebo, irrespective of relatedness, were observed in 100% of the patients in the intervention group and 99.2% in the placebo group. Serious adverse events occurred in 8.6% of the patients in the intervention group and 2.5% of those in the placebo group; anaphylaxis occurred in 7.8% and 3.4%, respectively. Serious treatment-related adverse events occurred in 0.4% of patients in the intervention group and none in the placebo group. Treatment-related anaphylaxis occurred in 1.6% in the intervention group and none in the placebo group. In this trial involving children 1 to 3 years of age with peanut allergy, epicutaneous immunotherapy for 12 months was superior to placebo in desensitizing children to peanuts and increasing the peanut dose that triggered allergic symptoms. (Funded by DBV Technologies; EPITOPE ClinicalTrials.gov number, NCT03211247.).